mercaptopurine and Mouth-Diseases

Thiopurines are widely used as first-line immunosuppressive therapies in the management of chronic inflammatory oral disease. However, despite over half a century of clinical experience, the evidence base for their use is limited. The aims of this paper were to review the evidence for the use of thiopurines in oral medicine and provide a contemporary model of thiopurine metabolism and mechanism of action and a rationale for clinical use and safe practice.

Topics: Azathioprine; Dose-Response Relationship, Drug; Drug Interactions; Humans; Immunosuppressive Agents; Mercaptopurine; Mouth Diseases; Risk Factors; Thioguanine

Langerhans cell histiocytosis (LCH) is a rare disease characterized by abnormal proliferation of bone marrow-derived histiocytes (Langerhans cells). LCH may manifest orally with single or multiple lesions of the alveolar or basal bone. Ulcerated mucosal lesions may be accompanied by periodontal lesions that present with gingival inflammation, bleeding, recession, necrosis, toothache, dental hypermobility, tooth development abnormalities, and premature tooth loss. This paper presents the case of a five-month-old boy with very early oral manifestations of LCH and describes the combined systemic and dental treatment during a 36-month follow-up. A combined local and systemic approach may be necessary to control oral disease manifestations.

Topics: Cytarabine; Drug Therapy, Combination; Follow-Up Studies; Glass Ionomer Cements; Histiocytosis, Langerhans-Cell; Humans; Immunosuppressive Agents; Infant; Male; Mercaptopurine; Methotrexate; Mouth Diseases; Prednisone; Vinblastine

Modified BFM-90 regimen has significantly improved the outcome of lymphoblastic lymphoma in children and adolescents. Infection is the main side effect of this regimen, which may affect the treatment efficacy and prognosis without proper intervention. This study was to summarize the characteristics of the modified BFM-90 regimen related infection, and explore effective approaches to treat the infection.. The infection rate, site, pathogen were reviewed for the infections of 104 children and adolescents suffering from lymphoblastic lymphoma at different phases of the modified BFM-90 regimen. The relationship between chemotherapy, bone marrow suppression and infection was analyzed. The value of procalcitonin (PCT) in identifying the infection type and the outcome of anti-infection treatment was evaluated.. The infection rates in reduction phases Ia, Ib and re-reduction phases IIa, IIb were 52.5%, 60.7% and 48.6%, 28.2%, respectively. The infection rate in consolidation chemotherapy for patients with low to intermediate risk and high risk were 17.2% and 100%, respectively. In total 302 infections occurred. One hundred and sixty-seven cases (55.3%) had documented infection sites, most of which happened to the respiratory tract. Ninety-five cases (31.5%) had documented pathogens, most of which were Gram-negative bacteria. Infections of 262 cases (86.8%) were secondary to bone marrow suppression. The sensitivity and specificity of PCT in diagnosing sepsis were 83.3% and 70.2%, but it failed to identify the infection type. After the anti-infection treatment, 296 cases were cured, four cases gave up further treatment due to financial difficulties, two cases died of sepsis.. Infections caused by modified BFM-90 regimen for lymphoblastic lymphoma in children and adolescents are closely correlated to bone marrow suppression. The positive diagnosis rate of the pathogen is too low to identify most of the infection type. The treatment still mainly depends on experience.

Topics: Adolescent; Anti-Bacterial Agents; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Bacterial Infections; Cephalosporins; Child; Child, Preschool; Cross Infection; Cyclophosphamide; Cytarabine; Daunorubicin; Disease Progression; Female; Humans; Itraconazole; Male; Mercaptopurine; Methotrexate; Mouth Diseases; Mycoses; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Recurrence; Remission Induction; Respiratory Tract Infections; Vincristine

Topics: Child; Common Cold; Hepatitis B; Humans; Influenza, Human; Leukemia, Lymphoid; Male; Mercaptopurine; Methotrexate; Mouth Diseases; Prednisone; Remission, Spontaneous; Time Factors; Ulcer; Vincristine

Topics: Adrenocorticotropic Hormone; Adult; Antimetabolites; Coal Tar; Dermatitis, Exfoliative; Glucocorticoids; Humans; Hydrocortisone; Male; Mercaptopurine; Methotrexate; Mouth Diseases; Oral Manifestations; Prednisolone; Psoriasis; Sepsis; Skin Diseases; Ulcer